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Type: Journal article
Title: Labour pain with remifentanil patient-controlled analgesia versus epidural analgesia: a randomised equivalence trial
Author: Logtenberg, S.
Oude Rengerink, K.
Verhoeven, C.
Freeman, L.
van den Akker, E.
Godfried, M.
van Beek, E.
Borchert, O.
Schuitemaker, N.
van Woerkens, E.
Hostijn, I.
Middeldorp, J.
van der Post, J.
Mol, B.
Citation: BJOG: an International Journal of Obstetrics and Gynaecology, 2017; 124(4):652-660
Publisher: Wiley
Issue Date: 2017
ISSN: 1470-0328
Statement of
SLM Logtenberg, K Oude Rengerink, CJ Verhoeven, LM Freeman, ESA van den Akker, MB Godfried, E van Beek, OWHM Borchert, N Schuitemaker, ECSM van Woerkens, I Hostijn, JM Middeldorp, JA van der Post, BW Mol
Abstract: Objective: To distinguish satisfaction with pain relief using remifentanil patient-controlled analgesia (RPCA) compared with epidural analgesia (EA) in low-risk labouring women. Design: Randomised controlled equivalence trial. Setting: Eighteen midwifery practices and six hospitals in the Netherlands. Population: A total of 408 pregnant women at low risk for obstetric complications initially under the care of primary-care midwives. Methods: Women randomised before active labour to receive analgesia with RPCA or EA, if requested. Main Outcome Measures: Primary outcome was satisfaction with pain relief measured hourly using a visual analogue scale and summed as area under the curve (AUC). Secondary outcomes were overall satisfaction with pain relief, pain intensity scores during labour, mode of delivery, and maternal and neonatal outcomes. Results: We randomised 418 women, of whom 409 could be followed for the primary endpoint. Analgesia was received by 46% (94/203) in the remifentanil group and 37% (76/206) in the epidural group. The AUC for satisfaction with pain relief was 32 in the remifentanil group and 31 in the epidural group (mean difference -0.50; 95% CI -6.8 to 5.9). Among women who actually received analgesia, these values were 23 and 35, respectively (mean difference -12; 95% CI -22 to -1.5). Secondary outcomes were comparable. Conclusions: In low-risk labouring women, we could not demonstrate equivalence between a strategy with RPCA to EA with respect to satisfaction with pain relief assessed during the total duration of labour. However, once applied satisfaction was higher in women who received epidural analgesia.
Keywords: Epidural analgesia; labour pain; pain intensity score; pain satisfaction score; remifentanil patient-controlled analgesia; satisfaction with pain relief
Rights: © 2016 Royal College of Obstetricians and Gynaecologists
DOI: 10.1111/1471-0528.14181
Appears in Collections:Aurora harvest 8
Obstetrics and Gynaecology publications

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